Thank you for your interest in Private Healthcare Systems. Please use the following form to request more information about PHCS and our services. Please note: If your health plan ID card carries the PHCS logo and you have questions about your benefits, including those about coverage, co-payments, claims, deductibles and premiums, you will need to contact your insurance company, human resources representative or health plan administrator directly. Your health plan's telephone number can usually be found on the back of your ID card. If you would like to search for a PHCS provider, please access our online provider search.   Contact Information   * indicates a required field * Name: * Title: * Company Name: * Company Address: * City: * State: Select State... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Zip:  -  Phone Number: ( ) -   Ext. * E-mail Address:   Areas of Interest   * Which services are you interested in? PHCS Network Services PHCS Care Management Both   Company Information   * Business Type (please check one): MCO or HMO Insurance Carrier Third Party Administrator Taft-Hartley Employer Broker Consultant   * Number of Covered Lives: greater than 2,000 less than 2,000   Additional Information   * For which states would you be interested in accessing the PHCS Network? (Hold down CTRL key for multiple selections) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   * How did you hear about PHCS? Print advertisement Newspaper Tradeshow Internet Other :